Pakistan medical education crisis

Pakistan medical education crisis Medical education in the doldrums... Medical education in Pakistan is going through a serious crisis. With the significance attached to it as a major component of the social sector, one would have expected a little more official concern towards this vital area. Yet different stakeholders are working for their own benefit at the cost of the national healthcare delivery mechanism. The government and its various functionaries, public-sector institutions and the Pakistan Medical and Dental Council (PMDC) - which is responsible for the monitoring and standardisation of medical education - have all apparently lost interest in this regard. It is therefore understandable that people with vested interests have taken over. In the last two years, the PMDC recognised all medical and dental colleges that applied for registration. There was only one exception which, by the looks of it, lacked the 'right' political and financial connections. While we have as many as 92 PMDC-recognised medical colleges in the public and private sectors, the majority of them struggle to meet even the minimal PMDC requirements as regards to faculty, space and facilities. It is also a fact that the PMDC has allowed several of these colleges to increase their induction quota. The least expensive of medical colleges in the private sector charges at least Rs400,000 per student per annum, making it one of those rare businesses in which millions can be earned without having to make a proportionate investment. In terms of faculty, there is an acute shortage of educationists to impart instruction in basic medical sciences such as anatomy, physiology, biochemistry, pharmacology and histology that are taught during the foundation years. There was a proposal to have a shared faculty so that, for example, a professor of anatomy would embark on a teaching tour to various medical colleges. The owners of private medical colleges were quite enthusiastic about the idea but are reluctant to merge colleges. The reason is obvious: by sharing a professor, they stand to cut their salary bill which will increase profits. Public-sector medical colleges are in the same boat. Bolan Medical College in Balochistan is in a pathetic situation, while the newly opened college in Swat has an acute shortage of faculty in all departments. Some colleges in Sindh and Punjab are also faculty-deficient. Dow International Medical College, a public-sector entity charging a massive fee in foreign exchange, allegedly has faculty and facilities only on paper. The situation on the clinical side is not too different either. Clinical teaching is not possible without professionals who are willing to spend time in wards, outpatient departments and emergency rooms. There is hardly any practical training under proper supervision worth its name. During the previous government the then health minister, who was a graduate of Liaquat Medical College at Jamshoro, converted his alma mater into a full-scale medical university. He argued that this would organise medical education along scientific lines in the province. With the Higher Education Commission providing the millions that were needed, the Liaquat University of Health and Medical Sciences came into existence through an executive order, and without any feasibility study having been undertaken. Immediately afterwards, the health minister of Punjab decided to have a medical university in his province. Thus came into existence the Punjab University of Health Sciences. Since then a plethora of medical universities have sprung up across the country.With so many universities one hoped that everybody would have been satisfied, but that is not the case. No studies have been undertaken on what effective change has been brought about by the hundreds of millions that have been spent on these fancy universities. They have started PhD and MPhil programmes but the quality of training and teaching is obvious in departments where faculty members are not qualified to deliver. One of the first things that ought to have been done after all these institutions achieved university status was to convert part-time medical institutions into full-time educational centres. That, however, was never on the agenda. The focus was on construction and purchasing equipment, which could never have had any impact on the basic structure of training. The current government's decision to turn medical colleges in Larkana and Nawabshah into universities is also rooted primarily in politics. There is no valid reason to hope that they will be any different from their predecessors in terms of approach and execution.It is time someone in authority did a serious, sincere and professional audit of the billions issued in grants. Did the grant have any impact on the quality of teaching? Was the money well spent? In terms of postgraduate training, a number of programmes are run by various institutions but are plagued with the same malaise that is the fate of their undergraduate counterparts. The establishment of universities has in fact only exacerbated the situation. Every institution now wants to start some training programme or the other to justify its existence even though most of them have neither the infrastructure nor the human resources for a structured training programme that would produce specialists. Medical curricula and training programmes need to be developed according to the needs of the local people. What we are doing is training doctors to work abroad. Medical students and postgraduate trainees are not exposed to the masses and their afflictions. No wonder we have a very high maternal mortality rate, we have failed to eradicate polio, our neonates are dying, we are unable to save the eyes of young children and our basic health units, rural health centres and taluka hospitals are non-functional. Furthermore, a large number of doctors have no ethical considerations. This is because we initiate programmes without thinking, planning and setting definite goals. The common man and his problems are nowhere in sight when we make decisions. There is a need to form a high-powered committee or commission on medical education to address these issues. Such a commission should justify the need for profit-oriented medical colleges and their role in the country's healthcare system, and examine the role of medical universities in the war against sickness and disease. Dawn